Long-term discontinuations of botulinum toxin A intradetrusor injections for neurogenic detrusor overactivity: a multicenter study

Data on long-term outcomes of intradetrusor injections of botulinum toxin A (BTX-A) for neurogenic detrusor overactivity (NDO) are lacking. The aim of the present manuscript was to assess the outcomes of intradetrusor injections of BTX-A for NDO after more than 10 years of follow-up.

A retrospective chart review of all consecutive neurological patients who had received either onabotulinumtoxin A or abobotulinumtoxin A intradetrusor injections for NDO between January 2002 and November 2007 at three academic centers, was performed. The primary outcome measure was 10 years discontinuation rate. Other outcomes of interest were: failure, reasons for discontinuation and subsequent treatments of NDO. Discontinuation-free and failure-free survivals were estimated using Kaplan-Meier analyzes.

140 patients were included in the study. Ten-year discontinuation-free survival and failure-free survival rates were 49.1% and 73% respectively. The most common reason for discontinuation was failure (43.7%; primary and secondary in 17.2% and 26.5% of cases respectively). Secondary failure occurred after a median number of 8 injections and a median time of 80.1 months from the first injection. Other reasons for discontinuation were: patient's decision (28.1%), non BTX-A related improvement of urinary incontinence (14.1%), progression of the neurological condition (12.5%) and adverse event (1.6%). Discontinuation-free survival was significantly poorer in spina bifida patients compared to patients with multiple sclerosis or spinal cord injury (p= 0.02).

Over a half of NDO patients discontinue intradetrusor BTX-A within the first 10 years after the first injection. Spina Bifida patients are at high risk of discontinuation.

The Journal of urology. 2018 Oct 22 [Epub ahead of print]

Maximilien Baron, Benoit Peyronnet, Annabelle Aublé, Juliette Hascoet, Evelyne Castel-Lacanal, Gabriel Miget, Sabine Le Doze, Thomas Prudhomme, Andrea Manunta, Jean-Nicolas Cornu, Xavier Gamé

Department of Urology, University of Rouen, Rouen, France., Department of Urology, University of Rennes, Rennes, France. Electronic address: ., Department of Urology, University of Rennes, Rennes, France., Department of Physical Medicine and Rehabilitation, University of Toulouse, Toulouse, France., Department of Physical Medicine and Rehabilitation, University of Rouen, Rouen, France., Department of Physical Medicine and Rehabilitation, Functional re-education and rehabilitation center "Le Normandy", Granville, France., Department of Urology, University of Toulouse, Toulouse, France.